Loss of bone tissue around the implant: diagnosis, treatment, prevention

At PerioDent, we know!

THE INFORMATION PROVIDED IN THE ARTICLE CANNOT BE USED TO ESTABLISH A DIAGNOSIS OR APPOINTMENT OF TREATMENT AND IS NOT A SUBSTITUTE FOR THE CONSULTATION OF A PHYSICIAN.

Everyone knows that dental health determines the quality of our lives. That is why dental implants have become an advanced method of restoring chewing function after tooth loss. And this is not surprising, because implant placement helps us return to a full life – we can once again eat our favourite foods, communicate and smile without restrictions.

However, many patients are unaware of the possible risks, including bone loss around the implant, which can occur over time.

Therefore, in this article, we will take a closer look at the causes, symptoms, and how to prevent bone loss to maintain your beautiful and healthy smile.

Why does bone loss occur?

We often see primary patients with a loss of bone stability around the implant, accompanied by crown mobility, pain, discoloration, or volume of the gums and bone around the implant.

First of all, we:

→ perform a computed tomography scan

→ collect information about the patient’s implant system, peculiarities of home care for orthopedic structures, the presence of chronic diseases, and lifestyle.

Therefore, based on our many years of experience, we can identify the main causes of bone loss near the implant.

Subjective (independent of the specialist’s work):

• trauma
• neglect of oral hygiene
• the presence of chronic diseases (diabetes mellitus, osteoporosis, etc.)
• loosening of the screw fixation of the crown and the patient’s neglect of the need to visit the dentist.

Surgical:

• erroneous or insufficient diagnosis – the presence of a patient’s pathology that was not identified or eliminated before the implants were placed, for example, periodontitis
• insufficient distance between the installed implants (installation of several implants too close to each other)
• selection of an implant of an inappropriate size
• incorrect depth of implant placement
• insufficient width of the keratinized gums to ensure stable attachment
• bacterial plaque that is too close to the level of bone tissue, which causes it to be lost when trying to move away from the irritant, to reduce this risk, the doctor should ensure that the plaque is formed at as great a distance from the bone surface as possible.

Orthopedic:

• instability of the abutment (the occurrence of micro-mobility, which directly affects the level of bone adjacent to the implant)
• cement fixation of the crown (cement residues near the gums, which are almost impossible to remove at the stage of prosthetics due to the peculiarities of the abutment structure, which can lead to implant diseases such as mucositis and peri-implantitis)
• incorrect selection of the shape and height of the titanium base / orthopedic elements
• incorrect selection of materials for the manufacture of the crown, such as gold or composite, which affects the attachment of the gums to the orthopedic structures (the lack of it can lead to the accumulation of bacterial plaque near the bone, which will contribute to its resorption).

How to recognize the symptoms of bone loss?

How do you know if you need to see a dentist immediately?

The following symptoms may indicate this

pain in the area where the implant is placed
mobility of the crown
changes in the color or volume of the gums and bone around the implant.

Prevention of bone loss:

After treatment, we teach patients to take care of their dental health by caring for their implants at home. You can read more about these rules in the article:

But if you are planning to install an implant for the first time, an important step is the choice of specialists, because your surgeon, orthopedist, and dental technician must understand the design features of the implant system they use in their practice.

At PerioDent, we try to prevent bone loss at all stages of treatment:

during the initial consultation:

1) we carry out a full diagnostic complex, including a number of computed tomography scans, panoramic and targeted radiographs

2) we make a photographic protocol, collect a complete health history, and check for chronic and concomitant diseases, such as gingivitis and periodontitis

3) if necessary, we first improve the anatomical conditions, stabilize the periodontal condition and restore the attachment of the gums to the teeth

assess the level of bone tissue, if necessary, perform augmentation, sinus lift, or directed bone regeneration
assess the level of soft tissues (to ensure stable attachment to the future crown, their level should be at least 3 mm), and taking into account this indicator, if necessary, we eliminate defects of the gums or oral mucosa or transplant soft tissues. This method is used to
increase the volume of the gums in the areas of intermediate crowns of bridges
increase the volume of soft tissue after tooth extraction to preserve the size of the bone, as well as surgical modeling of the gum margin

implantation planning in accordance with orthopedic rehabilitation:
We develop templates and prosthetic schemes
select the implant system and materials for further prosthetics, the shape, and height of the titanium base / orthopaedic elements
develop an individual treatment plan

ensure correct prosthetics and create conditions for plaque to form at the greatest possible distance from the bone surface to prevent the activation of a biological defense mechanism aimed at “escaping” the bone from pathogenic microorganisms
we use the method of screw fixation of crowns to the implant instead of cement, which helps to ensure reliability, allows proper hygiene and repair of orthopedic structures in the long term (in addition, dismantling prostheses fixed with cement often leads to damage to the screws or the structure as a whole, which in turn can affect the cost of the manipulation)
in the manufacture of crowns and bridges, our dental technicians use materials with a high level of biocompatibility with soft tissues, in particular zirconium oxide and lithium disilicate, which provide strength and are well cleaned with a manual or sonic brush, and the physical features of these materials help to reduce the zone of microbial plaque, thus reducing the risk of inflammation and ensuring the adaptation of adjacent tissues
application of high-quality facing ceramics to the zirconium oxide framework, which will ensure the aesthetic and functional result of orthopedic treatment and reduce the risk of cracks, chips, and detachment of the ceramic from the crown framework.

Impact on health and aesthetics:

Bone loss can affect the aesthetics of your smile and your overall health.

Along with bone loss, there is usually a process of gum recession, which can make the implant more visible and affect the aesthetic appearance, which in turn can provoke gum infection or inflammation. As a result, there may be a change in the shape and volume of the jaw, which will affect the natural volume of the face, its contour, and the overall aesthetics of the smile.

Treatment and restoration:

If you are faced with the problem of loss of bone stability around the implant, PerioDent offers the most advanced treatment and restoration methods. In particular, in the case of a lack of attached gums, we perform gingival augmentation followed by correct prosthetics.

If the bone loss is associated with re-implantation (due to insufficient hygiene) or cemented crowns (cement residues were in contact with the bone), we perform implant debridement, a procedure for cleaning and removing bacterial plaque and pathogenic microorganisms from the implant surface.

In the most difficult cases, when the bone loss is more than 50% of the implant surface, we perform its extraction with subsequent correct surgical and orthopedic rehabilitation.

In addition, we teach proper and thorough oral hygiene to prevent recurrence in the future.

To summarise, maintaining a stable level of bone tissue around implants depends on the interaction of a whole range of conditions that depend on both doctors and patients. The main thing is to pay attention to your health and visit your dentist regularly.

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